Day 9: Glasgow Coma Scale

There is something beautiful about the fluidity and logic of medical procedure.  There's a certainty, and trust in the methods.  Personal protection equipment, sterile technique, ABC, CPR, life before limb, Maslow's...  It's breathtakingly elegant.  One of those tools in this vast, and deeply intertwined flow chart is something called the "Glasgow Coma Scale," which is a pain for new nurses, because (like APGARs) is more numbers to remember, but at the same time, it's such an essential tool to assess the condition of a patient. It tells you how bad a patient is doing, and how much worse, or how much better they're getting.  GCS should be executed within seconds in a trauma situation, and if you need practice under mock pressure (but you don't have access to a trauma center as a clinical site/you need a break from studying), I would suggest the SKY1 drama "CRITICAL" starring Lennie James.  It's about the golden hour of what happens in the trauma bay when the patient is first rolls in (drowning, stabbing, motorcycle vs semi, explosion), and one thing the doctors and nurses always do is assess GCS on the patient while blood is gushing out by the cup, and they can't establish an airway, and there are monitors and alarms blaring around them telling them that their patient is literally seconds from dying.  If you can still do a GCS in that environment, you have arrived, my friend.

So what is GCS?  GCS is the gold standard for level of consciousness, and it's a scale from 3-15.  15 is all systems go, you're as alive as it gets.  3 means you're operating a brain stem level.  8 and below is coma.  The three categories of stimuli being tested is eye response, verbal response, and motor response.

Decorticate and decerebrate always confuses me.  Both things have to do with the CNS (corti- and cerebr-), but I remember the difference by saying "De-CORE-ticate" is trying to hold an object close to my core, which helps me to imagine twisting midline and flexing my arm and fists (as if around a pen, or marker, or something valuable like a purse) to bring my hand to my chest.

It's also to remember to document if there is another reason aside from the patient's injuries or the incidence that may be affecting GCS, so, like if the paramedics did a GCS on site, then gave morphine or ketamine, and then they arrived in the trauma bay and you'd have to redo the GCS, it would be natural for the number to be lower--they've been pumped with narcotics.  In that case, you identify:

"GCS: ___ c sedation ___mg of (name of medication) given IV  at  (time of administration) by paramedics: first and last name."

That way should anything happen and you go to court 5 years from now everything will have been written down.